Oppositional Defiant Disorder: Changing Diagnoses

Oppositional Defiant Disorder

The symptoms of oppositional defiant disorder as identified by the DSM have changed from DSM-4 to DSM-5. However, there has been some criticism of the new manual by physicians and psychologists, who lament the fact that Big Pharma played a substantial role in producing the manual. This point will be discussed later in the paper. For now, the symptoms as described in DSM-4 were: a demonstrated pattern (6 months or more) of negative and defiant behavior, including at least 4 of the following activities: frequent loss of temper, arguing with elders, refusal to conform to rules of elders, deliberately annoying, places blame for faults on others, testy, full of disrespect and scorn, full of spite and a desire to "get even." Furthermore, this behavior should impair the individual's ability to function socially, academically and/or occupationally, and these behaviors should be exhibited in ordinary situations -- not just during a mood or psychotic disorder. The individual should also not be diagnosed as having conduct disorder or antisocial personality disorder (American Psychiatric Association, 2000).

DSM-5 has refined these symptoms still further. The symptoms are grouped by type and range: "angry/irritable mood, argumentative/defiant behavior, and vindictiveness" (American Psychiatric Association, 2013, p. 15). Also, the "exclusion criterion" used in DSM-4 is no longer used, allowing for an easier diagnosis. Another change is that there is no severity rating that is determined by how pervasive the symptoms appear to be. The disorder is also lumped together with conduct disorder and intermittent explosive disorder under the heading Disruptive, Impulse-Control, and Conduct Disorders.

In a person, this disorder would look like the following: the individual would appear self-centered and consistently angry "about everything," as though there were a tremendous chip on his or her shoulder -- although this "chip" would not be in proportion with what the individual is actually "suffering" from others. The individual would be consistently disrespectful, as though he or she couldn't help but be rude and disrespectful to persons in authority. The individual would consistently challenge others and argue, which would diminish his or her ability to make friends, keep steady employment, or do well in school. In other words, the individual would be failing in all sectors of his or her life as the result of his or her "bad attitude" which seems to have no justification.

The media is rarely unbiased in its portrayals of disorders, as the more sensational a depiction, the more likely it is to attract viewers and therefore increase advertising revenue. The situation is no different with oppositional defiant disorder. The disorder has been romanticized to a high degree by iconic representations in media, such as the "rebel without a cause" type, which is romanticized in the sense that the individual with the disorder is perceived to have a good justification for his "attitude" but adults just do not understand it.